Health carriers and pharmacy benefits managers; prohibited conduct, civil penalty.
Summary
SB 1359 would require health carriers and pharmacy benefits managers (PBMs) to let covered individuals fill prescriptions at a network participating retail community pharmacy when the prescription is also available through mail order, so long as the retail pharmacy agrees to accept reimbursement equivalent to the mail-order rate. The bill also bars PBMs and carriers from imposing different copayments, fees, rebates, bonuses, or other conditions on a consumer who chooses a retail community pharmacy if those terms are not applied uniformly across all contracted pharmacies in Virginia.
In addition, the bill requires PBMs to disclose in their contracts with carriers whether they keep all or a larger share of manufacturer rebates or other remuneration for drugs dispensed through PBM-owned mail order pharmacies than they do for drugs dispensed through retail community pharmacies. The measure would apply to PBM contracts entered into, amended, extended, or renewed on or after January 1, 2026.
Impact
The bill would add a new section to the Virginia Code, § 38.2-3407.7:1, creating statewide rules for carrier administration of pharmacy benefits and for PBM contract terms involving retail community pharmacies and mail-order pharmacies. It would affect health carriers, PBMs, pharmacies, and covered individuals by limiting differential pricing and benefit design tied to pharmacy choice, and by increasing disclosure obligations around rebates and remuneration. The practical effect would be to expand consumer access to in-network retail pharmacies for mail-order-eligible prescriptions and to constrain PBM practices that favor mail-order channels.
Sentiment
The bill appears to have had limited support in the Senate Committee on Commerce and Labor, where it failed to report on a 5-9 vote. With no recorded committee testimony provided, the available voting history suggests the measure was controversial and did not command a majority in committee. The bill’s framing indicates a consumer-access and pharmacy-choice policy goal, but the defeat suggests significant resistance from members concerned about its effects on PBM contracting, reimbursement structures, or market operations.
Contention
The main points of contention are likely the bill’s restrictions on PBM and carrier pricing practices and its requirement that retail pharmacies be allowed to match mail-order reimbursement for eligible prescriptions. Supporters would likely view the bill as promoting patient choice, pharmacy access, and transparency in rebate retention, while opponents may argue it interferes with PBM business models, could increase costs, or complicate negotiated pharmacy networks. The disclosure requirement regarding rebate retention and remuneration from mail-order pharmacies versus retail pharmacies is another likely flashpoint because it targets PBM financial arrangements.